NPIMap

Organization Active NPI

Pediatric and Family Medical Center

  • Federally Qualified Health Center (FQHC)
  • Lynwood, CA
National Provider Identifier
1407268709
Registry record updated Apr 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PEDIATRIC AND FAMILY MEDICAL CENTER
Practice address
3680 E Imperial Hwy
Suite 200
Lynwood, CA 90262-2659
Phone
(310) 608-4898
NPI assigned
May 21, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Monica McCarthy
Title
Sr VP, Coo & Interim-Ceo
Phone
(213) 747-5542

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

3680 E Imperial Hwy
Suite 200
Lynwood, CA 90262-2659

Mailing address

3680 E Imperial Hwy
Suite 200
Lynwood, CA 90262-2659
Phone (310) 608-4898

Other names 1

  • Eisner Pediatric and Family Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160120000745 CA Part A Provider - Federally Qualified Health Center (FQHC) 1557301678 Practice locations: Lynwood, CA

Federally qualified health center certification: CCN 751830

Legal name
PEDIATRIC AND FAMILY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 8, 2015
Last certification
Dec 8, 2015
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 1, 1920 in CA
Enrollment address
3680 E Imperial Hwy
Ste 200
Lynwood, CA 90262-2663

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Pediatric Family Medical C13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3680 E Imperial Hwy
Ste 200
Lynwood, CA 90262
Phone (310) 608-4898

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Sergey Navolnev Individual Corporate OfficerChief Financial Officer Jan 1, 2024
W-2 Managing EmployeeChief Financial Officer Jan 1, 2024
Irma Avila Individual Corporate DirectorConsumer Board Member Jul 1, 2011
Monica Gutierrez-McCarthy Individual Corporate OfficerPresident and Ceo Mar 29, 2021
W-2 Managing EmployeePresident and Ceo Mar 29, 2021
Tyler Vogler Individual Corporate OfficerChief Operations Officer Feb 3, 2025
W-2 Managing EmployeeChief Operations Officer Feb 3, 2025
Martine Singer Individual Corporate DirectorBoard Member Nov 1, 2018
Edward Matthews Individual Corporate DirectorVice-Chair Jul 5, 2011
Stan Berkman Individual Corporate DirectorBoard Member May 1, 2015
Christopher Isola Individual Corporate DirectorBoard of Directors Member Jun 8, 2023
Alejandra Rosas Rodriguez Individual Corporate DirectorConsumer Board Member Jul 1, 2011
Rupert Grant Individual Corporate DirectorBoard Member Jul 1, 2014
Kevin J Rossi Individual Corporate DirectorChair Jul 3, 2011
Ian Weiner Individual Corporate DirectorTreasurer Jul 1, 2013
Victor Aguirre Individual Corporate DirectorConsumer Board Member Jul 1, 2011

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400630400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713398400000",
    "number": "1407268709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3680 E IMPERIAL HWY",
            "address_2": "SUITE 200",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902622659",
            "telephone_number": "310-608-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3680 E IMPERIAL HWY",
            "address_2": "SUITE 200",
            "city": "LYNWOOD",
            "state": "CA",
            "postal_code": "902622659",
            "telephone_number": "310-608-4898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC AND FAMILY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-21",
        "last_updated": "2024-04-18",
        "certification_date": "2024-04-18",
        "status": "A",
        "authorized_official_last_name": "MCCARTHY",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "SR VP, COO & INTERIM-CEO",
        "authorized_official_telephone_number": "213-747-5542"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eisner Pediatric and Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eisner Pediatric and Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lynwood, CA

Sources for this page

Verify at the official NPI Registry.